Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. | Hacker News Reader

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

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63 pointshelium41 comments

As I've said before, this article is incredibly wrong and quite misleading. If you ever wanted evidence that most Americans do not understand how medicines are developed or what the Placebo Effect is, this article (and the responses here) serve as ample evidence.

For a more rigorous refutation by a trained professional, please read: http://www.sciencebasedmedicine.org/?p=1248

I'll pull the zinger quote from the article above for you:

>No, it’s not like that at all. Perhaps the studies are just that well done, or maybe the drugs being developed suck, or maybe companies are studying more candidate drugs and screening for efficacy. Just about any explanation that doesn’t involve aliens is better than “placebo is getting stronger”.

It is really so ridiculous to think that there is some drug such that:

* The drug provides a modest health improvement.

* That health improvement happens to be smaller than the health improvement do to the placebo effect?

I don't know what the typical magnitude of the placebo effect is. If it is substantial, then actually working, actually helpful drugs might be being denied to people. The very mechanisms for the placebo effect he hypothesizes (e.g. people taking care of their health when on a study) certainly seem like they might vary with our culture...

All I can say is, you do not know what the Placebo effect is. You don't understand why you cannot use it as a therapeutic invention. You do not understand why most drugs benefit from the placebo effect already.

Please, pleasepleaseplease go and read up on what it actually is.

Woah there tiger-- where do you get that I am suggesting using the placebo as a therapeutic invention!? (If it makes any difference, I meant to type "due to" rather than "do to"). I am suggesting that the following situation might exist:

1) Drug A is 5% effective

2) Placebo is 10% effective

3) No one ever gets the benefits of drug A, since its benefits are masked during trial.

A placebo gets used to determine the margin of error for a particular test. The drug being tested must show significant improvements over the placebo's measurements in order to prove that it is effective.

If your theoretical Drug A performs worse than the placebo, then the effectiveness that it had should be considered to be within the margin of error, and therefore not better than taking nothing at all.

Well... But since placebos can't be used therapeutically, and Drug A can, doesn't that make it better than nothing?

If the drug can't outperform the placebo, then it doesn't make it better than nothing because you're adding chemistry to your body without any assurance that it's going to actually do anything.

But "the placebo" is not a static thing. If we designed experiments differently, the placebo effect might be able to be reduced (say to 3%), in which case drug A would now beat it.

I would speculate that when placebos appear to work, it is primarily because they don't do anything, besides possibly providing some increased hope to the patient, allowing the body to work without the "side" effects of drugs. The human body naturally tries to heal itself to the best of its ability.

Here's a very interesting example of placebos being administered on a routine basis, for years.

  Natural Hygiene, as it is today, can be traced back to Dr Isaac
  Jennings (of Oberlin, Ohio, USA) who, after practising medicine for 20
  years, began to ask questions when, during a fever outbreak in the
  summer of 1815, a patient who rested, drank water and did nothing,
  recovered in absolute record time compared to patients who had been
  medicated. Based on this, Dr Jennings noted similar results with many
  other patients.

  He then went on to treat many patients with what must have been one
  of the first placebo (dummy pill) treatments. In 1822 he gave up
  medical pills, plasters, powders and potions and treated patients with
  pills made from bread and vegetable-coloured water for the next 20
  years. This he only did to keep the patients’ confidence in him. He
  would then advise his patients to correct their lifestyle and diet to
  a more natural approach. He then practised for a further 20 years the
  "do nothing mode of treating disease." He wrote three books, "Medicine
  Reform" (1847), "Philosophy of Human Life" (1852) and "Tree of Life"
  (1867).

  Natural hygiene was often referred to at this stage as Orthopathy
  meaning TRUE or RIGHT AFFECTION or BEHAVIOUR.

  Dr Jennings had a great influence upon Dr R T Trall, who went on to
  do more for the hygiene movement than any man, next to Dr Herbert
  Shelton.

http://www.mary-anns.com/Natural%20Hygiene.htm

I've read this account on other sites as well. The Jennings story can be verified by other sources online. His deliberate use of placebo for so many years is fascinating.

More information here on Jennings: http://naturalhygienesociety.org/past2.html

I would speculate that when placebos appear to work, it is primarily because they don't do anything

I like your argument but, amazingly, there's some research that seems to indicate that placebos affect a physical change. In cases where heroin was used as a pain killer, a placebo could be blocked using the same chemical that blocks the effect of heroin.

Here's more: http://www.newscientist.com/article/dn7892

And as a further consequence -- real naloxone blocks the effects of placebo morphine.

http://news.ycombinator.com/item?id=567913

You have to bear in mind that before the germ theory of disease (late 19th century) and then penicillin (mid 20th century) doctors didn't know what was causing most disease, and couldn't do anything about it if they did.

Homeopathy hangs around today partly because for many years it provided an alternative to mainstream medicine that was more likely to kill than cure you. The standard 'medicines' were leeches, bleeding, laxatives and emetics to make you throw up. Magic water was, at that time, a sensible alternative by comparison.

Perhaps researchers are finding the placebo effect more successfully due to a sort of meta-placebo effect. They're expecting to observe it, so they do... ;)

My theory concerning the increasing placebo effect is pharmaceutical advertising. We are increasingly hearing the message "pill X will cure problem Y"; this primes us for the placebo effect.

Just one of the positive effects of drug ads.

When I read this article, I got hung up on the part about the scientists studying the biochemical pathways of the placebo effect. How interesting. It saddens me to think he doesn't get much funding.

And then I had this thought: What if he developed a pill that caused an artificial biochemical release of the chemicals responsible for the placebo response. A non-placebo that triggers a placebo response in your body. Hmmmm. How would you even a test such a pill?

I just wonder if it would help some patients, if you could buy placebos. I mean branded placebos: "This is the placebo used in trial x and y and shown to have positive effect on z and w".

That might be an ethical way to sell placebos (homeopathy is at the moment demonstrating the unethical one) — I just don't know whether it would be as effective. Are placebos also effective when you know fully well that you take nothing more than a sugar pill? I don't think so.

You know you are taking a sugar pill with a demonstrated effect. That might do it.

How would you do a trial for that? Placebo placebo?

You could offer multiple placebos.

For example, here you have your basic generic white placebo which costs $5 a pill, which we all know is totally worthless because it is made out of sugar. Now, you sir are insured, so if you want you can have this cutting edge blue PlaCeBo (TM) -- just between you and me, it costs like $80 a pill and has nothing in it but sugar but who cares, insurance covers it. Alternatively we have the PlaSeBo which is the cheap Chinese knockoff and hasn't killed anybody this week that we know of, not that that is too surprising, because it is made out of sugar.

There have been trials of placebos against placebos. That's how it has been established that more placebos are more effective than fewer and also how the shape and colour of the tablets relates to their effectiveness. If you want some references on this, look up Bad Science by Ben Goldacre. It's a good read, btw.

What if there is no psychological effect? Maybe the sugar pill is a weak panacea for all our ills.

Apparently placebos are effective, even when you know it's a placebo. See http://www.placebo.com.au/node/31 for a reference to research on this (on the site of a company that sells placebos...)

It's kind of like band-aids for kids - they cure all manner of ills (even when there is no wound).

Interesting, but I'm skeptical.

'Non-blind' means that patients were informed that the pills they were issued were totally inert, that they were placebos, and in this case they were also assured that despite this the pills would be of benefit to them. The study concluded: 'The primary finding is that patients can be willing to take placebo and can improve despite disclosure of the inert content of the pills; belief in pill as drug was not a requirement for improvement.'

They tell the subjects something that's bound to be confusing to most people. I don't know that there wasn't "belief in the pill as a drug". If the test were done only with subjects with a scientific background, or if they omitted the assertion about the benefit, it would be more convincing.

No they are not. This is Homeopathy "works".

I initially read your comment as 'I wonder if it would help (them) to patent placebos" and then reading it properly realised my mistake. I'm sure there have to be some in the pharma industry hoping to turn this into a moneyspinner somehow.

Obecalp: "Ms. Buettner, 40, who lives in Severna Park, Md., with her husband, 7-month-old son and 22-month-old twins, envisioned a children’s placebo tablet that would empower parents to do something tangible for minor ills and reduce the unnecessary use of antibiotics and other medicines.

With the help of her husband, Dennis, she founded a placebo company, and, without a hint of irony, named it Efficacy Brands. Its chewable, cherry-flavored dextrose tablets, Obecalp, for placebo spelled backward, goes on sale on June 1 at the Efficacy Brands Web site. Bottles of 50 tablets will sell for $5.95. The Buettners have plans for a liquid version, too."

http://www.nytimes.com/2008/05/27/health/27plac.html

All well and good until some kid dies because his mom gave him Obecalp instead of his Cancer drugs because she thought it was "all in his head".

I seriously hope they've had their lawyers do their homework on this one.

Previously http://news.ycombinator.com/item?id=783912

Yes, here the duplicate detector for this older article was beat by submitting the print version, which opened a printer dialog on my computer.

http://blogs.wnyc.org/radiolab/2009/12/28/placebo-rebroadcas...

Very good episode of RadioLab about the same topic.

I've not had a chance to read the article yet, will do so if I get a chance over lunchtime. However, the posting reminded me of an Radiolab story I listened to over the weekend that explores this topic as well and had some good observations about the power of mind over matter.

http://blogs.wnyc.org/radiolab/2009/12/28/placebo-rebroadcas...

I wonder if people think placebos are magically "getting more effective" because people in the US are actually taking way more drugs today than they actually need to? Out of all my friends back home in the states almost all of them are on some kind of prescription for something. One couple pays over $2k per month for medication! Is all this really necessary? In this couple's case, some of the drugs are apparently only needed to counter the effects of some of the others.

By the late '90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail.

Really? Does this pass the smell test? I've never taken Valium [1], but I'm pretty sure its effects are strong and clear, to the point of creating serious addictions.

[1] On second thought, I probably have, as a pre-op, and yes the effects were obvious and unlikely to be replicated by a sugar pill.

What does "it was likely to fail" mean. But it didn't. ...witness, yes, countless addicts. I've worked professionally (as biofeedback therapist) with scores of users of valium (and its cousins), and the withdrawal can be tricky/agonizing.

Valium tends to produce tolerance pretty quickly. As a one-time administration of a pre-op dose, you would notice the difference.

Chronic use of a lower dose for anxiety symptoms separates from placebo at first, but not after 2-3 months.

Remember that the article is about placebos having more effect now than in the past. So yes, Valium really does have effects. But if you did a double-blind study vs. a placebo today, it might not perform better than the placebo.

Maybe it's the added sugar in the placebos that makes them so effective?

I stopped reading this half way down. Is there anything in the article except blether?

The first half seemed to be saying 'Drugs companies do tests against placebos. Merck is short of drugs.' Can someone who took the trouble to plough through it summarise the second half?

If you read long enough (sigh, I gotta get a life), you will find the article has the likely answers to the question.

"But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products.

[...]

"Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind. [...] By evoking [...] uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response."

It also speculates that cultural differences (including the consequences of "outsourcing" testing) influence the placebo effect, and that psychiatric drugs are especially susceptible to the placebo effect ("...[a challenge] is to accurately define the nature of mental illness")

Lots of self-hoisting on petards going on in the drug business, otherwise known as the Law of Unintended Consequences. http://en.wikipedia.org/wiki/Unintended_consequence

Cool, thanks!

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